Davis's Drug Guide for Nurses

doripenem (do-ri-pen-em)

Doribax

Classification

Therapeutic: anti-infectives

Pharmacologic: carbapenems

Pregnancy Category B

Copyright © 2009 by F.A. Davis Company

Indications

Infections caused by susceptible organisms including : complicated intra-abdominal infections, complicated urinary tract infections, including pyelonephritis.

Action

Inhibits bacterial cell wall formation.. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against the following gram-positive organisms: Acinetobacter baumanii, Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, and Pseudomonas aeruginosa. Also active against the following gram-negative organisms: Streptococcus constellatus and Streptococcus intermedius. Anaerobic spectrum includes Bacteroides caccae, Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, and Peptostreptococcus micros.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Penetrates renal and peritoneal and retroperitoneal tissues and fluids.

Metabolism and Excretion: Mostly excreted unchanged in urine; minimal metabolism.

Half-life: 1 hr .

TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK DURATION
IV unknown end of infusion 8 hr*
*Normal renal function

Contraindications/Precautions

Contraindicated in: Hypersensitivity to doripenem, other carbapenems or beta-lactams..

Use Cautiously in: Geri : Consider age-related decrease in renal function when choosing dose; OB : Use cautiously during lactation; Pedi : Safe use in children has not been established..

Adverse Reactions/Side Effects

CV: headache. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, ↑ liver enzymes. Hemat: anemia. Local: phlebitis. Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS, infection with resistant organisms, superinfection.

Interactions

Drug-Drug: None noted.

Drug-Natural: May ↓ blood levels of valproic acid; this may result in loss of seizure control. Probenecid ↓ renal clearance and ↑ blood levels.

Route/Dosage

IV (Adults): 500 mg every 8 hr.

Renal Impairment

IV (Adults): CCr 30–50 ml/min—250 mg every 8 hr; CCr >10–<30 ml/min—250 mg every 12 hr.

Availability

Powder for injection (requires reconstitution: 500 mg/vial.

NURSING IMPLICATIONS

Assessment

Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
Obtain a history before initiating therapy to determine previous use of and reactions to penicillins, cephalosporins or carbapenems. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Have epinephrine, an antihistamine, and resuscitative equipment close by in the event of an anaphylactic reaction..
Lab Test Considerations: May cause ↑ AST, ALT, serum alkaline phosphatase levels.
May cause anemia.

Potential Nursing Diagnoses

Risk for infection ( Indications, Side Effects)

Implementation

May switch to appropriate oral therapy after at least 3 days of parenteral therapy, once clinical improvement has been demonstrated.

IV Administration

Intermittent Infusion: Reconstitute 500-mg vial with 10 mL of sterile injection or 0.9% NaCl and shake gently to form a suspension of 50 mg/mL. Diluent: Withdraw the resulting solution using a 21–gauge needle and add it to 100 mL of 0.9% NaCl or D5W; gently shake until clear. For moderate or severe renal impairment, withdraw 55 mL of this solution from the bag and discard. Solution should be clear and colorless to slightly yellow. Concentration: Final concentration is 4.5 mg/mL. Suspension is stable for 1hr prior to dilution in infusion bag. Administer within 8 hr of reconstitution with 0.9% NaCl or 4 hrs of reconstitution with D5W at room temperature or 24 hr if refrigerated; do not freeze.

Rate:

Y-Site Incompatibility: Do not mix with or physically add to solutions containing other medications.

Patient/Family Teaching

Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy. Consult health care professional before treating with antidiarrheals.
Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication..

Evaluation/Desired Outcomes

Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection. Duration may be extended up to 14 days for patients with concurrent bacteremia.